Study of some immunological markers in acute cerebrovascular ischemic stroke

Ischemic stroke is associated with a high rate of mortality and morbidity in the world. Several mechanisms for neuroprotection against ischemia have been studied and included inflammatory mediators and apoptotic inducers and suppressors. The aim of this study was to clarify the role of some immunological markers [TNF-alpha, sFas and BCL-2] in the pathogenesis of cerebral ischemia and to relate their levels to the size of brain infarction and prognostic outcome of ischemic stroke. This study was done on 60 patients suffering from acute cerebrovascular ischemic stroke [40 males and 20 females] with age ranged from 45-70 years and 15 healthy subjects as a control group. History taking, clinical examination, laboratory investigations were performed to all subjects and CT scan brain was done for patients. There was a highly significant statistical difference between the patients and control group as regard the level of the immunological markers and there was a direct relationship between risk factors as TIAs and TNF-alpha level and sFas level among the patients with increased level of these 2 markers in comparison to those with normal level. On the other hand, there was an inverse positive relationship between presence of hypertension, diabetes and TIAs and BCL-2 level among the patients with decreased level of BCL-2 in comparison with those with normal level. Also, there was a highly significant positive correlation between both of TNF-alpha level and sFas level and signs of inflammation as fever, elevated ESR and leukocytosis in the patients and a significant positive correlation with the NIH-NINDS score of stroke. While there was a highly significant negative correlation between BCL-2 level and WBCs, ESR and NIH-NINDS score. There was a direct positive relationship between both of TNF-alpha level and sFas level and size of brain infarction and presence and degree of brain oedema among the patients while an inverse positive relationship was found between these CT parameters and BCL-2 level. There was a significant statistical difference between survived and died groups of patients as regard BCL-2 level and qualitative presence of CRP+. Neuronal death in acute ischemic stroke is attributed in part to inflammation and apoptosis

High frequency of IgM antiphospholid antibodies in young Iranian patients with stroke

To investigate the presence of IgG and IgM types of anticardiolipin [aCL] and antiphospholipid [aPL] antibodies in younger Iranian patients with ischemic stroke. Both IgG and IgM types of aPL [cardiolipin, anti phosphatidyl inositol, anti phosphatidyl serine, anti phosphatidic acid and beta 2-glycoprotein I [B2-GPI]] and aCL alone [cardiolipin and B2-GPI] were measured in 117 patients with ischemic stroke [aged <45 years] during an 18-month period from September 2002 to March 2004 in Al-Zahra Hospital, Isfahan, Iran. The demographic, clinical, and laboratory characteristics of patients with a positive titer were recorded. Seven men and 16 women [23 patients, 19.6%] had increased IgG types of aPL antibodies. Increased titers of IgM and IgG were found in 19 [82.6%] and 6 [26%] patients for aPL antibodies and in 15 [83.3%] and 8 [44.4%] cases for aCL alone. Despite European studies, high titers of IgM aPL antibodies found in a large number of patients can be caused by the presence of unknown triggering factors [infections or poisons], that are more prevalent in developing countries compared to developed countries. This hypothesis remains to be investigated further

Antiphospholipid antibody positive young stroke: an analysis of 12 cases.

AIMS AND OBJECTIVES: To study clinico-investigative profile of 12 young (<45 years) patients with stroke who tested positive for anti phospholipid antibodies (APLA). SUBJECTS AND METHODS: The diagnostic, clinical, laboratory and radiologic features in 12 APLA positive young patients who presented with stroke were studied. The APLA analysis included estimation of anticardiolipin (aCL) antibodies and lupus anticoagulant (LA). Other relevant tests included anti-nuclear antibody, human immunodeficiency virus, Venereal Diseases Research Laboratory, platelet count, echocardiography and carotid Doppler. APLA positive strokes were those cases where either the immunoglobulin G (IgG) and immunoglobulin M (IgM) were raised or LA was positive, and other known causes were excluded. RESULTS: Levels of IgG (aCL) was raised in 11 cases (mild 7, moderate 1, high 3), IgM was elevated in all the 12 cases (moderate 2, high 10). Of the two LA positive cases both were IgM positive but in one IgG was negative. Five patients showed small multiple bilateral cerebral infarcts on computerised tomography (CT) scan. 5 patients had history of recurrent strokes. Hemiparesis was more frequent than hemiplegia. None presented with dense hemiplegia. All patients recovered to normal functional capacity and did not have recurrence on drugs. CONCLUSION: A preliminary study on APLA positive young strokes showed certain clinical and radiological features, mild to moderate stroke, pre-treatment recurrences, multiple smaller infarcts on CT, which could be clustered in a subgroup of stroke in young. Incidentally these patients showed a good prognosis in terms of long term outcome.